Endometrial cancer in elderly women: which disease, which surgical management? A systematic review of the literature

International audienceObjective: Endometrial cancer primarily affects elderly women. The aim of the present literature review is to define the population of elderly women with this disease and to define the characteristics of this cancer in elderly people as well as its surgical treatment. Materials and Methods: A systematic review of the English-language literature of the last 20 years indexed in the PubMed database. Results Endometrial cancer is more aggressive in elderly women. However, surgical staging performed in elderly patients is often not concomitant with the disease’s aggressiveness in this group. Mini-invasive surgery is performed less often, for no obvious reason. Of note, oncogeriatric evaluation was not usually ruled out to determine the most appropriate surgical modality. Conclusion: Studies are needed to evaluate surgical management of endometrial cancer in elderly women, notably with the aid of oncogeriatric scores to predict surgical morbidity

Serum CD95L level correlates with tumor immune infiltration and is a positive prognostic marker for advanced high grade serous ovarian cancer

International audienceSoluble CD95L (s-CD95L) is a chemoattractant for certain lymphocyte subpopulations. We examined whether this ligand is a prognostic marker for high grade serous ovarian cancer (HGSOC) and whether it is associated with accumulation of immune cells in the tumor. Serum s-CD95L levels in 51 patients with advanced ovarian cancer were tested by ELISA. Immunohistochemical staining of CD3, CD4, CD8, CD20, CD163, CD31, FoxP3, CCR6, IL-17, Granzyme B, PD-L1, and membrane CD95L was used to assess tumor-infiltrating immune cells. Although the intensity of CD3, CD8, CD4, CD20, and CD163 in tumor tissues remained constant regardless of membrane CD95L expression, tumors in HGSOC patients with s-CD95L levels > 516 pg/ml showed increased infiltration by CD3+ T cells (p = 0.001), comprising both cytotoxic CD8+ (p = 0.01) and CD4+ (p = 0.0062) cells including FoxP3+ regulatory T cells (p = 0.0044). Also, the number of tumor-infiltrating CD20+ B cells (p = 0.0094) increased in these patients. Multivariate analyses revealed that low s-CD95L concentrations (6000 CD3+ cells (HR, 0.34; 95% CI, 0.15-0.79) was a good prognostic factor. Thus, low levels of s-CD95L (<516 pg/mL) are correlated with lower numbers of tumor-infiltrating lymphocytes (CD3+ and CD8+, but also CD4 and FoxP3 T cells) in advanced HGSOC and are a poor prognostic marker. Implications Serum s-CD95L is correlated with the number of tumor-infiltrating immune cells in HGSOC and could be used as a non-invasive marker of tumor immune infiltration to select patients referred for immunotherapy trials that evaluate checkpoint inhibitor treatment